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Thursday, June 25, 2009

End of Life Decisions

He was only a dog, but Fraggles taught us some important lessons that can also be applied to humans. Face it. Sometimes, unexpected things happen. Perhaps you will be a patient in the hospital leaving your loved ones to face the difficult decisions on your behalf, because you are unable to make them for yourself.It may be difficult to talk about these things, because you don't want to think something tragic can happen to you. The obvious question is, "Why not you?"Maybe you will not be able to talk about it to another person. Maybe you will have to just write your thoughts down, all by yourself. These instructions are termed a "living will" or "advanced directive," or something similar.Based on our experience with our pet, I have some ideas. The first is, Don't go to a research or university hospital, if you have the choice. There are many reasons for this, but the basic one is that they exist partly to help and partly to learn, i.e., the patient is partly an experiment to help them gain knowledge about what treatments may work. Another reason to avoid the researchers is that many of the physicians are students or interns, still in their learning phase. Let them learn stuff on other people!Another major decision we had to make with the dog was whether or not to have them resuscitate the patient if his heart stopped. With an animal, the decision-makers can not know what choice the patient would make for himself, and that puts a lot of emotional stress on the loved ones.One woman in my Bible study group commented that her mother had told the family, "Don't let them put that tube down my throat. That thing hurt me so much when they did it, before." The family knew the mother's choice when the need arose the next time, and chose to honor her wishes.The third major decision that needs to be made is financial. Dogs don't have Medicare or Medicaid, and most owners don't think about health/accident insurance for their pets (but it is available). Before every procedure, the Veterinarian would let my wife and me know the charge that would be involved. Three hundred dollars for a blood transfusion didn't appear too unreasonable, if it would give Fraggles a fighting chance. Resuscitation would be more than one thousand dollars. Beyond it all was the surgeries that would be needed to repair the broken bones, if he survived to that point, and those would also be in the thousands.When one applies this logic to a human patient, the costs can erase all the family assets and leave the family penniless.The other important issue for the family is the pain question. Is he in pain? For dogs, you just trust the Vet and hope. For humans, there is a tradeoff between being sedated and being cognitive. Is there something you would want to communicate to your loved ones? If he is overly sedated, the patient may not be able to tell you something important, but if he is under sedated, he may experience pain.There you have some important lessons the death of our beloved Fraggles taught us about hospitalization.For me, I know where I am going, next, so I don't want you to do something that will unnecessarily keep me here. For me, I don't want to have any experimental treatment, especially any treatments not covered by insurance. For me, experiencing quality time with family members is more important than minimizing pain.What about you? Tell your loved ones.